Sexual Stigma, Criminalization, Investment, and Access to HIV Services Among Men Who Have Sex with Men Worldwide

Abstract

Globally, HIV disproportionately affects men who have sex with men (MSM). This study explored associations between access to HIV services and (1) individual-level perceived sexual stigma; (2) country-level criminalization of homosexuality; and (3) country-level investment in HIV services for MSM. 3,340 MSM completed an online survey assessing access to HIV services. MSM from over 115 countries were categorized according to criminalization of homosexuality policy and investment in HIV services targeting MSM. Lower access to condoms, lubricants, and HIV testing were each associated with greater perceived sexual stigma, existence of homosexuality criminalization policies, and less investment in HIV services. Lower access to HIV treatment was associated with greater perceived sexual stigma and criminalization. Criminalization of homosexuality and low investment in HIV services were both associated with greater perceived sexual stigma. Efforts to prevent and treat HIV among MSM should be coupled with structural interventions to reduce stigma, overturn homosexuality criminalization policies, and increase investment in MSM-specific HIV services.

HIV Treatment Cascades that Leak: Correlates of Drop-off from the HIV Care Continuum among Men who have Sex with Men Worldwide

“…For MSM, HIV responses at the country level continue to be seriously hampered by daily experiences of stigma, discrimination, violence and criminalization [17][18][19][20]. MSM who live in countries that criminalize homosexuality have higher mean scores on perceived homophobia scales and decreased access to basic HIV services, including access to ART, compared to MSM who live in countries with more supportive legal frameworks [21].…”

Anti-Homosexual Legislation and HIV-Related Stigma in African Nations: What Has Been the Role of PEPFAR?

“…HIV prevalence among men who have sex with men is difficult to characterize, as few resources are devoted to measuring it, but the limited studies conducted generally conclude it is significantly higher than in the general population [15] In 2014, the US Department of State's Office of the US. Global AIDS Coordinator acknowledged: 'Human rights among lesbian, gay, bisexual and transgender [LGBT] people in certain parts of the world are increasingly under threat, creating additional barriers to key populations obtaining services' [20].…”

The future of drugs: recreational drug use and sexual health among gay and other men who have sex with men

“…Criminalisation of these activities is known to work against public health and creates barriers to engagement in care. 38,111,112 The digital context has only multiplied potentials for the apprehension and surveillance of those who engage in 'illicit activities'. Redressing the moral and legal status of these activities is of utmost importance.…”